Korean J Gastroenterol.  2016 Aug;68(2):99-103. 10.4166/kjg.2016.68.2.99.

Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient

• Lee SW
• Lee HS

• KMID: 2350087
• DOI: http://doi.org/10.4166/kjg.2016.68.2.99

Abstract

Gastric mucormycosis is a rare and life-threatening fungal disease, caused by fungus in the order Mucorales. While rhino-cerebral and pulmonary forms are common, gastric mucormycosis is an uncommon site for the disease. We diagnosed gastric mucormycosis in a 41-year-old female who had severe multiple trauma, including cardiac rupture, due to a traffic accident. Eighteen days after hospitalization, she passed 800 mL of melena over one day. We performed upper esophagogastroduodenoscopy (EGD) and found a huge gastric ulcer with bleeding. Histopathological examination identified non-septated and right-angled branching fungal hyphae, and we diagnosed gastric mucormycosis. We recommended total gastrectomy to her but she refused the operation, so she was treated with liposomal amphotericin B for 53 days. After two months of treatment with liposomal amphotericin B, we again performed EGD and found a healed gastric ulcer. After four months, with another EGD, we found that the gastric mucormycosis was completely healed.

Keyword

Gastric mucormycosis; Immunocompetent; Heart rupture; Amphotericin B

MeSH Terms

Accidents, Traffic
Adult
Amphotericin B
Endoscopy, Digestive System
Female
Fungi
Gastrectomy
Heart Injuries*
Heart Rupture
Hemorrhage
Hospitalization
Humans
Hyphae
Melena
Mucorales
Mucormycosis*
Multiple Trauma
Stomach Ulcer
Amphotericin B

Figure

• 

  Fig. 1. Abdominal CT finding. Irregular gastric wall thickening and air-bubble formation at gastric wall (arrow) were seen. Both pleural effusions were also found.

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  Fig. 2. Endoscopic findings after melena episode. Huge gastric ulcer with bleeding at great curvature side of gastric body and fundus, covered with yellowish exudate.

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  Fig. 3. Histopathologic findings shown as multiple broad-based, non-septated, right-angle branched fungal hyphae (arrow) with tissue infiltration in H&E (A, ×200), periodic acid-schiff stain (B, ×200), and Gomori methenamine silver stain (C, ×200).

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  Fig. 4. Endoscopic findings four weeks after starting amphotericin B treatment, showing improving gastric ulcer with surrounding regenerating mucosa at cardia and proximal body.

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  Fig. 5. Endoscopic finding 16 weeks after starting amphotericin B treatment. Gastric ulcer scar formation without rugal fold formation was seen at proximal body.

Reference

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